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Evolution of Lipodystrophy Syndrome and Lipidic Profile in HIV Patients after Switching from Protease Inhibitors to Efavirenz E. BONNET, R. LEPEC, M. BLUTEAU, R. HERVE, J. BERNARD, B. PERRET, J. IZOPET, and P. MASSIP.
Hôpital Pupan, Toulouse, France
The mechanisms of lipidic disorders and lipodystrophy syndrome in HIV-patients
are not well known, they are probably multifactorial. Since protease inhibitors
(PI) have been suspected to play a major role in these abnormalities,
we conducted a prospective study to evaluate the evolution of hyperlipidaemia
and lipodystrophy syndrome in HIV-patients after switching from PI to
efavirenz.
We conducted a prospective non comparative study including 43 HIV-patients
(35 male and 8 female). Inclusion criteria were : i) HIV-patients with
at least one year of PI containing regimen, ii) viral load below 50 copies/ml
on two consecutive blood samples (three months before inclusion and on
day 0), iii) clinical lipodystrophy including loss of peripheral fat and
increase in central fat, iv) fasting triglyceride > 2 mmol/l.
Nucleoside reverse transcriptase inhibitors were maintained and PI was
replaced with efavirenz. On day 0 (D0), month 3 (M3) and month 6 (M6),
all patients were subjected to : i) a routine physical examination (including
body weight and body mass index), ii) measurements of legs, thighs, abdomen
(ombilic, hips) and chest perimeters, iii) routine biological parameters
(including CD4-cell count and viral load), iv) complete evaluation of
lipidic profile (including triglyceridaemia, total cholesterolaemia, HDL,
LDL, VLDL, Apo A1, Apo B, Apo CIII, Apo E, LpB:e, LpB:C3, Lp:a measurements,
and v) evaluation of fat/thin masses distribution by dual X-ray absorptiometry
(DEXA).
Preliminary results showed no improvement in lipidic profile or lipodystrophy
syndrome (on physical examination and DEXA).
* = Trunk Fat Mass, ** = Lower Limbs Fat Mass, ° = Body
Fat Mass
Whereas CD4-cell counts were maintained and viral load remained undetectable
in all patients.
Conclusion: As mentioned in other studies, no improvement is observed
in lipidic abnormalities and lipodystrophy syndrome in HIV-patients switching
from PI to a non nucleoside reverse transcriptase inhibitor. Although
values of virologic and immunologic parameters were maintained and compliance
was very good.
Key Words: Lipidic disorders, Lipodystrophy, Protease inhibitors
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